This podcast and blog post are based on Level C evidence – consensus and expert opinion. Examples of protocols, checklists and algorithms are for educational purposes only and require modification for your particular needs as well as approval by your hospital before use in clinical practice.

Practical tips on managing yourself, your team and your patients in the COVID-19 pandemic

Sara Gray’s 4 step COVID wellness program

Normalizing: Know that your stress, anxiety and fear is normal

Remember that you’re not alone; we’re all in this together – stay connected

Make a happy list – a list of activities that brings you joy or comfort or peace or are refreshing including a) physical activity, b) mindfulness, c) emotional wellness

Make your strategies explicit by making a schedule, tell other people about your happy list

Beware of anchoring bias in the COVID era

Not every patient who presents with fever has COVID, and even those with documented COVID and get sick with another diagnosis. Keep your differential diagnosis wide as you would before the COVID era so that you don’t miss alternate important life or limb threatening diagnoses. Keep your eye out for the many diagnoses that could be masquerading as COVID-19.

Time management tips during the COVID era

Limit yourself to one hour per day (with a timer set) to learn about COVID-19 using the time in a structured, deliberate and purposeful way.

Choose your top 6 sources for COVID-19 information and stick with them, which can be divided into direct (correstpondance from hospital), text-based (e.g. up to date, quickicutraining.com), audio source, social media source (Forbes’ currated list of COVID experts to follow on Twitter), big picture source.

Mute the noise! Use ‘do not disturb’ mode on your iphone or zenmode for android phones.

To stay connected with the medical community during COVID and find the best COVID hacks in real time try the free app developed by Andrew Cameron https://pandemos.care/

Pediatric COVID management considerations (March 30th, 2020)

Disease severity is low in children compared to adults perhaps due to lack of the ACE-2 receptor and/or a decreased immune response resulting in respiratory failure, however there are case reports of pediatric deaths and ARDS-like respiratory failure in teenagers

There is no evidence that COVID-19 causes croup, bronchiolitis or asthma exacerbations in children

For these illnesses, in general, minimize nebulized treatments while maintaining standard of care

Data from China suggests that 10-30% of pediatric COVID-19 patients present with GI symptoms, a higher percentage than adults

Both ibuprofen and acetaminophen have been endorsed by the Canadian Pediatric Society for fever in children with COVID-19

Don’t forget to screen the parents as well as the pediatric patient!

Vertical transmission of COVID-19 has occurred in newborns (3/33 newborns to COVID+ mothers according to JAMA pediatrics study)

Croup – our expert recommends administering nebulized epinephrine with full airborne precautions for children with croup who present with stridor; there is no evidence for IM epinephrine in croup; epinephrine MDIs are available on special release in some jurisdictions and would be preferable to nebulized epinephrine. Health Canada will likely not be approving epinephrine MDIs.

Asthma – our expert recommends the use of MDIs for every asthma patient which has shown to be as effective as nebulized treatment

Ventilatory support – most children who require ventilatory support at present require it for reasons other than COVID-19, therefore there is no recommendation for “early intubation” in children as some experts have recommended for adult patients, however for teenagers, adult guidelines should be followed; in smaller children we need to balance the risk of generating aerosolized virus from intubation or CPAP with patient harm caused by inappropriate intubation of children with asthma or bronchiolitis.

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.

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Emergency Medicine Cases (EM Cases) is a free online medical education podcast, medical blog and website dedicated to providing online emergency medicine education and CME for physicians, residents, students nurses and paramedics. We are Canada’s most listened to emergency medicine podcast with thousands of subscribers, well over 6 million podcast downloads since 2010 and are proudly part of the #FOAMed community. In each Main episode podcast 2 or more experts in a particular emergency medicine topic join Dr. Helman in a round-table, case-based discussion on key practice changing clinical emergency medicine topics, which are then carefully edited to maximize your learning. EM Cases’ Journal Jam podcast brings together world-renowned researchers and educators to keep you up to date on key research papers in EM, the EM Quick Hits podcast has 5 minute segments from 10 experts in specific challenging EM topics, and the Best Case Ever podcast has guest experts sharing their tacit knowledge on particularly interesting cases. We also offer the CritCases blog and Waiting to Be Seen blog as well as eBooks, Rapid Reviews Videos of the main episode podcasts, POCUS Cases videos, a Quiz Vault, and interactive courses.
Our Team, is headed by EM Cases founder and host Dr. Anton Helman. Our Advisory Board includes prominent leaders in the faculty of the University of Toronto Divisions of Emergency Medicine. Our Guest Experts, which number more than 100 in total, North America’s brightest minds in emergency medicine, are carefully chosen for each episode topic.
EM Cases is made possible by the support of The Schwartz/Reisman Emergency Medicine Institute (SREMI), a non-profit academic institution whose mission is improve research and education in Emergency Medicine.